The Social Dynamics of Health

The U.S., like most industrialized countries, has seen a remarkable decline in death rates from heart attacks, strokes, and other cardiovascular disease (CVD) during the past half century—a drop of more than 60 percent—thanks to improvements in prevention and treatment. This is a big reason why most of us will live much longer than our grandparents.

But this progress against CVD may be halted or even reversed in the next two decades, largely because of increasing disparities in social factors that shape our lives, according to a scientific statement from the American Heart Association, published in September 2015 in the journal Circulation. Even now, these disparities help explain why the U.S. has higher death rates from CVD (and from many other causes) than almost all other developed nations, though we spend far more money per person on health care.

The new paper clearly describes how an interconnected web of health-related social factors divides the U.S. into a country of “haves” and “have nots.” According to the authors, “the benefits of advances in prevention and treatment [of CVD] have not been shared equally across economic, racial, and ethnic groups.”

It’s hardly news that being poor, having a lower educational level, and having less access to medical care is a health hazard. People with low socioeconomic status are more likely to smoke and be obese, and they tend to die younger, largely from CVD. They tend to live in underserved neighborhoods where there’s less access to healthy food, less opportunity for physical activity, less social support, more exposure to pollutants, and increased stress due to crime, noise, and traffic. Social disadvantage and prejudice, starting in childhood, can result in lasting adaptations to chronic stress that seriously undermine health and are hard to reverse.

What can be done about this challenge we face to improve our health as a nation? “We’re used to public health programs that educate people to know their blood pressure or cholesterol numbers,” said Dr. Edward Havranek, the chair of the committee that wrote the AHA paper. “We’re less comfortable with public health programs focused on getting three-year-olds into daycare programs, which may improve their health down the road. We might be less accustomed to—but need—public health programs that look at how urban planners can improve neighborhoods that are seeing higher rates of cardiovascular disease.”

Individual actions such as working against racial discrimination or taking part in local efforts to improve education are essential and have long-term effects well beyond those you can immediately see. Most important, societal measures such as raising the minimum wage, enacting legislation that reduces income inequality, investing in public health programs for the least advantaged, and making health care accessible for all (which will require more than just the Affordable Care Act) will not only improve American lives but also prolong them.